Also known as niagen, nicotinamide riboside (NR) is an alternative form of vitamin B3. It exerts its anti-aging effects when the body converts it into nicotinamide adenine dinucleotide (NAD+), a helper molecule (coenzyme) that is present in all living cells. NAD+ is essential for several important biological processes including the conversion of food into energy, DNA repair, regulation of immune function, and regulation of the body’s internal clock. Boosting NAD+ levels in the body has been shown to produce several health benefits.  Nicotinamide riboside can be found in small amounts in fruits, vegetables, meat, and milk.
The conversion of nicotinamide riboside into nicotinamide adenine dinucleotide (NAD+) allows the body to perform various important biological processes. This includes energy production from food, DNA repair, regulation of immune function, and regulation of the body’s internal clock.
Nicotinamide riboside is converted by the body into nicotinamide adenine dinucleotide (NAD+), a helper molecule (coenzyme) that is present in all living cells and is essential for a broad range of biological functions. To put it simply, nicotinamide riboside is required in order to boost the levels of NAD+ in the body. Studies show that increased NAD+ levels are associated with a longer lifespan. [1-5] This suggests that boosting NAD+ levels through nicotinamide riboside supplementation may help extend lifespan.
Another mechanism that is known to extend lifespan is through increasing sirtuin (SIRT) activity. Increased SIRT activity has been shown to stabilize telomeres (located at chromosomes ends) and attenuate age-related telomere shortening.  Interestingly, studies found that individuals with longer telomeres have a longer subsequent lifespan. [7-8] With increased SIRT1 activity, the telomeres are more stable and their length increases which in turn extends lifespan.
Nicotinamide riboside-mediated increase in NAD+ activates SIRT1, an enzyme that plays an integral role in the regulation of proteins involved in cellular metabolism and processes associated with longevity, inflammation, and stress. SIRT1 activation removes acetyl groups from transcriptional regulators such as FOXO1 (Forkhead box protein O1) and PGC-1alpha (Peroxisome proliferator-activated receptor-gamma coactivator). This in turn causes metabolic adaptation, a survival mechanism that decreases the resting metabolic rate (number of calories burned at rest). As a result, cells undergo a process called mitochondrial biogenesis, which involves the production of new mitochondria (the powerhouse of cells). Mitochondrial biogenesis is critical for increased longevity since mitochondrial dysfunction in cells is associated with various age-related diseases and a shorter lifespan. [9-10]
A number of studies support that nicotinamide riboside can positively affect longevity mechanisms:
Nicotinamide riboside-mediated increase in NAD+ levels can slow down the signs of aging by preventing mitochondrial dysfunction, which contributes to cellular senescence (also known as biological aging), increased inflammation, decreased stem cell activity, reduced healing rate, and a decline in tissue and organ function.  By activating SIRT1, new and healthy mitochondria are formed through a process called mitochondrial biogenesis.
An increasing number of evidence supports the anti-aging effects of nicotinamide riboside:
NAD+ plays an integral role in energy production and regulation of a broad range of biological processes. One of the most important functions of NAD+ is generating a usable form of energy called adenosine triphosphate (ATP). By boosting NAD+ levels, nicotinamide riboside can also help increase energy levels which can improve exercise performance.
Studies suggest that nicotinamide riboside supplementation can help improve exercise performance:
Nicotinamide riboside boosts NAD+ levels which in turn increases energy expenditure. As a result, the body does not store additional fat. Moreover, evidence suggests that increased NAD+ levels are associated with increased metabolism.  All of these mechanisms can help promote weight loss.
The fat-burning properties of nicotinamide riboside are backed by a number of studies:
By boosting NAD+ levels, nicotinamide riboside can help attenuate the age-related decline in muscle mass and strength. This is because increased NAD+ levels are associated with enhanced ATP production and mitochondrial function and reduced muscle inflammation.  In addition, NAD+ is found to be a major player in skeletal muscle development and regeneration. 
Studies suggest that nicotinamide riboside can help prevent muscle degeneration and improve muscle health:
The ability of nicotinamide riboside to improve cognitive function can be attributed to its NAD+-boosting properties. NAD+ can help protect against brain disorders by decreasing the production of reactive oxygen species (ROS), which are linked to a wide array of medical maladies including neurodegenerative diseases.  NAD+ can also help prevent degeneration of nerve cells in the brain by regulating the activity of poly adenosine diphosphate-ribose polymerase 1 (PARP1). [42-43] Another mechanism that is important in boosting cognitive health is the ability of NAD+ to regulate the production of brain chemicals called neurotransmitters, such as dopamine, serotonin, and norepinephrine. These brain chemicals play an integral role in different cognitive functions such as memory, motivation, attention, mood, and emotions.
Studies show that nicotinamide riboside can be a therapeutic strategy in improving brain health:
Nicotinamide riboside-mediated increase in NAD+ levels can help promote normal heart function and enhanced cardiac recovery from injury. It has been shown that NAD+ activates SIRT3 which is associated with the prevention of heart enlargement and scarring. [59-61] Moreover, the mitochondrial conservation effects of NAD+ are known to play an integral role in inhibiting heart failure. 
Studies show that nicotinamide riboside can help protect against heart disease:
Cancer cells usually exhibit mitochondrial respiration malfunction and increased glucose uptake – both of these mechanisms can be prevented by increasing NAD+ levels.  In addition, increased NAD+ levels are known to boost the activity of SIRT1 and SIRT6, both of which are known to exert anti-tumor effects. [73-74] This suggests that nicotinamide riboside-mediated increase in NAD+ levels can help inhibit cancer growth.
The anti-cancer properties of nicotinamide riboside and its ability to treat the side effects of chemotherapy are backed by a number of studies:
Nicotinamide riboside can also be beneficial in people with hypertension because of its blood pressure-lowering effects. By boosting NAD+ levels, SIRT1 activation occurs which in turn increases the production of nitric oxide, a substance that helps widen blood vessels (vasodilation) to allow an increase in blood flow. This process reduces the pressure within the blood vessels.
Studies report that nicotinamide riboside has anti-hypertensive properties:
Nicotinamide riboside can also benefit people suffering from the unpleasant symptoms of diabetes and high blood sugar levels. It does this by boosting the levels of NAD+ which in turn enhances the body’s response to the blood sugar-lowering effects of the hormone insulin.
Evidence shows that nicotinamide riboside has anti-diabetic effects:
NAD+ is essential for brain health and may help protect against various brain injuries. Stroke is a condition wherein the blood supply to the brain is cut off or a blood vessel ruptures. NAD+ is known to improve blood circulation to the brain – a mechanism that may help prevent stroke. Since nicotinamide riboside boosts NAD+ levels, it may offer protective effects against stroke.
A good deal of evidence shows that nicotinamide riboside can help lower the risk of stroke and improve recovery through different mechanisms:
In acute kidney injury, substantial decreases in NAD+ levels are known to impair energy generation and affect the core function of the kidney.  In addition, decreased NAD+ levels also decrease sirtuin activity which contributes to the decline in kidney function. Thus, augmentation of NAD+ through nicotinamide riboside supplementation may help protect the kidneys and improve their health.
Nicotinamide riboside has been shown to play an essential role in maintaining optimal kidney function:
Nicotinamide riboside-mediated increase in NAD+ can also help protect against various eye disorders including the age-related decline in visual function. The modulation of sirtuin activity by NAD+ enhances retinal metabolism, reduces the death of eye cells, and improves vision. 
A number of convincing pieces of evidence suggest that nicotinamide riboside can help improve eye health:
Nicotinamide riboside side effects are very uncommon. There have been some side effects associated with the use of this drug wherein the patient had one of the issues listed below at some point while being on nicotinamide riboside. However, these side effects weren’t confirmed to be associated with the treatment and could have been a coincidence and not related to the use of nicotinamide riboside. Despite this, it was listed as a side effect associated with nicotinamide riboside even though these associated side effects are very uncommon.
Side effects associated with nicotinamide riboside may include the following:
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